AHCCCS Technical Interface Guidelines (TIG)

Behavioral Health Interface - Recipient Monthly Third Party Liability (TPL) File Layout

FIELD NAME	TYPE	SIZE	DESCRIPTION
SEQUENCE NUMBER	U	2	TPL sequence number Medicare data not included
PROCESSING DATE	X	6	YYMMDD
AHCCCS ID	X	9	Member's AHCCCS ID
LAST NAME	X	20	Member's Last Name
FIRST NAME	X	10	Member's First Name
SEX	X	1	Member's Gender
DATE OF BIRTH	X	8	Member's date of birth
POLICY ID	X	20	Policy ID number
INSURANCE TYPE	X	1	Insurance Type: M=Medical P=Pharmacy S=Medicare Supplemental
BEGIN DATE	X	8	Policy Begin Date
END DATE	X	8	Policy End Date
CARRIER NAME	X	30	Carrier Name
CARRIER PHONE	X	10	Carrier Phone Number
CARRIER STREET ADDRESS 1	X	23	Carrier Address)
CARRIER STREET ADDRESS 2	X	23	Carrier Address
CARRIER CITY	X	18	Carrier Address City
CARRIER STATE	X	2	Carrier Address State
CARRIER ZIP CODE	X	9	Carrier Address Zip Code
INSURED NAME	X	31	Insured Name
INSURED & PATIENT RELATIONSHIP	X	1	Relationship to policy holder: A - Absent Parent C - Child G - Guarantor L - Legal Guardian O - Other P - Parent S - Self
INSURED EMPLOYER	X	30	Insured employer
INSURED GROUP NUMBER	X	20	Insured Group Number
DATE RECORD ADDED	X	8	Date record was added
DATE LAST MODIFIED	X	8	Date record was last changed
DATE VERIFIED	X	8	Date record was verified
HEALTH PLAN ID	X	6	HP ID number
FILLER	X	5	(To be used for future expansion of the Master Carrier ID)
MASTER CARRIER ID	X	5	Master Carrier ID number from the Master Carrier reference file
IRR	X	80	Field not used